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General NPI Number Information
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NPI Number | 1588715791
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Entity Type | Organization
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Legal Business Name | WK BOSSIER ORTHOPEDIC & SPORTS
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 06/08/2012
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Provider Practice Location Address
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Address Line | 2449 HOSPITAL DR SUITE 340
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City | BOSSIER CITY
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State | LA
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Zip | 71111-2382
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Country | US
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Telephone | 318-212-7841
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Fax | 318-212-7846
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Provider Business Mailing Address
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Address Line | 2449 HOSPITAL DR SUITE 340
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City | BOSSIER CITY
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State | LA
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Zip | 71111-2382
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Country | US
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Telephone | 318-212-7841
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Fax | 318-212-7846
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Authorized Official
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Title or Position | NETWORK ADMINISTRATOR
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Name | GREG J. GAVIN
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Credential |
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Telephone | 318-212-4571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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